放射性粒子植入治疗颌面部恶性肿瘤的麻醉处理  

Anesthesia management for radioactive seed implantation in treatment of oral and maxillofacial malignant tumor

作　　者：杨旭东[1] 董稳[1] 张建国[2] 

机构地区：[1]北京大学口腔医院麻醉科,北京100081 [2]北京大学口腔医院颌面外,北京100081

出　　处：《国际口腔医学杂志》2009年第3期253-255,259,共4页International Journal of Stomatology

基　　金：首都医学发展科研基金资助项目(2005-2006)

摘　　要：目的探讨放射性粒子植入治疗颌面部恶性肿瘤手术麻醉处理的特点。方法根据不同的适应证,将放射性粒子植入治疗颌面部恶性肿瘤的患者76例分为局麻强化麻醉(LA组)、气管插管全身麻醉(TT组)和喉罩通气下的全身麻醉(LMA组),观察患者术中血压、心率和脉搏氧饱和度(SpO2)的变化以及麻醉诱导和维持的特点及并发症情况。结果LA组患者较TT组和LMA组患者术中心血管反应剧烈,术中最低SpO2低于术前且低于TT组和LMA组(P<0.05);术中体动和疼痛程度高于TT组和LMA组(P<0.05),1例发生低氧血症。TT组9例发生气管插管困难,气管插管一次成功率62.5%,1例术后因气道梗阻行紧急气管切开。LMA组一次置入成功率90%,与TT组术中的血流动力学和血氧比较差异无统计学意义(P>0.05),其中9例术中出现漏气音,但无低氧发生。结论在颌面部粒子植入手术中,不同的麻醉方法适用于不同的适应证且各有特点。其中,局麻强化可能镇痛不全,气管全身麻醉易出现插管困难,喉罩通气置入成功率高且应用安全有效。Objective To investigate characteristics of anesthesia management for radioactive seed implantation in treatment of oral and maxillofacial malignant tumor. Methods 76 patients with oral and maxillofacial malignant tumor receiving treatment of radioactive seed implantation were given three types of anesthesia according to indications： Local anesthesia plus intravenous sedation （group LA）, general anesthesia with endotracheal intubation （group TT） and general anesthesia with laryngeal mask airway （group LMA）. Changes of patients＇ blood pressure （BP）, heart rate （HR） and saturation of pulse oxygen （SpO2） during operation were recorded. Characteristics of anesthesia induction and maintenance and perioperative complications were observed. Results Among the 76 patients, 12 patients were enrolled into group LA, 24 patients were enrolled into group TT and 40 patients were enrolled into group LMA. Perioperative cardiovascular response in group LA was more intense than that in group TT and group LMA （P〈0.05）. The lowest SpO2 during operation of group LA was lower than preoperative value and than that of group TT and group LMA （P〈0.05）. Patients in group LA had more body movements and more pain than that in group TT and group LMA （P〈0.05）. One patient of group LA had hypoxemia during operation. In group TT, 9 patients had difficult intubation and the successful rate of first insertion was 62.5%. One patient of group TT received emergency tracheotomy because of postoperative airway obstruction. The successful rate of first insertion in group LMA was 90%. There was no difference between group TT and group LMA with respect to cardiovascular change and lowest SpO2. 9 patients of group LMA showed leakage during operation but no hypoxemia occurred. Conclusion In maxillofacial radioactive seed implantation surgery, different anesthesia methods should be chosen according to indications. Local anesthesia plus intravenous sedation is not likely to produce perfect analgesia, while general

关 键 词：麻醉 颌面部 恶性肿瘤 放射性粒子 

分 类 号：R782.054[医药卫生—口腔医学]